{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T16:52:02Z","timestamp":1784825522004,"version":"3.55.0"},"reference-count":50,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T00:00:00Z","timestamp":1635724800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Global and Sexual Health Research Group Department of Global Public Health Karolinska Institutet Stockholm Sweden","award":["Org number:202100-2973; Vat number:SE202100297301"],"award-info":[{"award-number":["Org number:202100-2973; Vat number:SE202100297301"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,10,15]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of this study was to determine the prevalence of infection, genotypes and risk factors for human papillomavirus (HPV) among men who have sex with men (MSM) and transgender women living with and without HIV in Pakistan. Anal infection with HPV is very common worldwide among MSM, particularly among MSM living with HIV. The high prevalence of HIV among MSM and male-to-female transgendered individuals in Pakistan is a significant health concern since access to screening and health-seeking is often delayed in this stigmatised key population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This cross-sectional study was conducted between March 2016 and November 2017.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants, setting and data collection<\/jats:title>\n                    <jats:p>This study recruited MSM and transgender-women who self-reported to have had anal sex in the last 6 months, and were at least 18 years of age, from the sexual health and antiretroviral therapy centres. Structured questionnaires were administered, and blood samples were obtained to confirm HIV status. Anal swabs were collected for HPV-DNA detection and typing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was the prevalence of \u2018HPV-DNA infection\u2019. The prevalence ratios (PR) were calculated using Cox proportional hazard model algorithms to analyse the association between exposure variables and HPV-infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Complete data were available for 298 MSM and transgender women (HIV +n=131; HIV\u2212n=167). The overall HPV-DNA prevalence was 65.1% and was higher in participants living with HIV as compared with HIV-negative (87% vs 48%; \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      p\u22640.001). Likewise, 28.9% of participants living with HIV were infected with two or more than two types of HPV as compared with 18.8% participants without HIV(\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      p\u22640.001). The most frequent HPV type was HPV6\/11 (46.9%), followed by HPV16 (35.1%), HPV18 (23.2%) and HPV35 (21.1%). HIV status (PR 2.81, 95% CI 2.16 to 3.82) and never condom use (PR 3.08, 95% CI 1.69 to 5.60)) were independently associated with prevalence of \u2018anal-HPV16 infection\u2019 when adjusting for confounding for age, other sexual and behavioural factors, for example, smoking and alcohol consumption.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High prevalence of HPV indicates a substantial future risk of anal cancer in Pakistani MSM and transgender women, and particularly in those living with HIV. Current findings support anal Pap-smear HPV screening for this particular group and vaccination efforts for future generations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-052176","type":"journal-article","created":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T13:17:11Z","timestamp":1635772631000},"page":"e052176","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Anal human papillomavirus infection among men who have sex with men and transgender women living with and without HIV in Pakistan: findings from a cross-sectional study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1187-9095","authenticated-orcid":false,"given":"Muslima","family":"Ejaz","sequence":"first","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"},{"name":"Community Health Sciences, Aga Khan University Medical College, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soren","family":"Andersson","sequence":"additional","affiliation":[{"name":"Lab Medicine, Orebro Universitet, Orebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salma","family":"Batool","sequence":"additional","affiliation":[{"name":"Molecular Biology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tazeen","family":"Ali","sequence":"additional","affiliation":[{"name":"Community Health Sciences & School of Nursing, Aga Khan University Medical College, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Mia","family":"Ekstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,11,1]]},"reference":[{"key":"2025121602015216000_11.11.e052176.1","first-page":"198","article-title":"The prevalence, incidence, persistence and transmission ways of human papillomavirus infection (HPV)","volume":"66","author":"Sehnal","year":"2017","journal-title":"Epidemiology"},{"key":"2025121602015216000_11.11.e052176.2","doi-asserted-by":"crossref","first-page":"4923","DOI":"10.1016\/j.vaccine.2017.07.078","article-title":"Targeted human papillomavirus vaccination for young men who have sex with men in Australia yields significant population benefits and is cost-effective","volume":"35","author":"Zhang","year":"2017","journal-title":"Vaccine"},{"key":"2025121602015216000_11.11.e052176.3","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70080-3"},{"key":"2025121602015216000_11.11.e052176.4","doi-asserted-by":"crossref","DOI":"10.1016\/j.currproblcancer.2019.06.008","article-title":"Correlation of human papillomavirus 16 and 18 with cervical cancer and their diagnosis methods in Iranian women: a systematic review and meta-analysis","volume":"44","author":"Fani","year":"2020","journal-title":"Curr Probl Cancer"},{"key":"2025121602015216000_11.11.e052176.5","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.3390\/jcm9051305","article-title":"Association of salivary human papillomavirus infection and oral and oropharyngeal cancer: a meta-analysis","volume":"9","author":"Rapado-Gonz\u00e1lez","year":"2020","journal-title":"J Clin Med"},{"key":"2025121602015216000_11.11.e052176.6","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2021.04.200588"},{"key":"2025121602015216000_11.11.e052176.7","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/S1473-3099(17)30653-9","article-title":"Human papillomavirus types from infection to cancer in the anus, according to sex and HIV status: a systematic review and meta-analysis","volume":"18","author":"Lin","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2025121602015216000_11.11.e052176.8","unstructured":"International Agency for Research on Cancer . 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